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1. EFAS Score - Multilingual development and validation of a patient-reported outcome measure (PROM) by the score committee of the European Foot and Ankle Society (EFAS).

Author

Richter M, Agren PH, Besse JL, Cöster M, Kofoed H, Maffulli N, Rosenbaum D, Steultjens M, Alvarez F, Boszczyk A, Buedts K, Guelfi M, Liszka H, Louwerens JW, Repo JP, Samaila E, Stephens M, and Witteveen AGH

Subjects
Adult, Europe, Female, Foot Diseases surgery, Humans, Language, Male, Middle Aged, Reproducibility of Results, Foot Diseases diagnosis, Foot Joints surgery, Orthopedic Procedures, Orthopedics, Patient Reported Outcome Measures, Societies, Medical, Surveys and Questionnaires
Abstract

Background: A scientifically sound validated foot and ankle specific score validated ab initio for different languages is missing. The aim of a project of the European Foot and Ankle Society (EFAS) was to develop, validate, and publish a new score(the EFAS-Score) for different European languages., Methods: The EFAS Score was developed and validated in three stages: (1) item (question) identification, (2) item reduction and scale exploration, (3) confirmatory analyses and responsiveness. The following score specifications were chosen: scale/subscale (Likert 0-4), questionnaire based, outcome measure, patient related outcome measurement. For stage 3, data were collected pre-operatively and at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using analyses from classical test theory and item response theory., Results: Stage 1 resulted in 31 general and 7 sports related questions. In stage 2, a 6-item general EFAS Score was constructed using English, German, French and Swedish language data. In stage 3, internal consistency of the scale was confirmed in seven languages: the original four languages, plus Dutch, Italian and Polish (Cronbach's Alpha >0.86 in all language versions). Responsiveness was good, with moderate to large effect sizes in all languages, and significant positive association between the EFAS Score and patient-reported improvement. No sound EFAS Sports Score could be constructed., Conclusions: The multi-language EFAS Score was successfully validated in the orthopaedic ankle and foot surgery patient population, including a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.co., (Copyright © 2018 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Published
2018
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2. EFAS Score - Multilingual development and validation of a patient-reported outcome measure (PROM) by the score committee of the European Foot and Ankle Society (EFAS)

Author

Jussi P. Repo, Michael M. Stephens, Maria Cöster, Hakon Kofoed, Nicola Maffulli, Per-Henrik Agren, Kristian Buedts, M. Guelfi, Henryk Liszka, Martinus Richter, Angelique G.H. Witteveen, Dieter Rosenbaum, Martijn Steultjens, Jan-Willem K Louwerens, Fernando Alvarez, Jean-Luc Besse, Andrzej Boszczyk, Elena Manuela Samaila, Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Stockholms Fotkirurgklinik, Sophiahemmet University, Laboratoire de Biomécanique et Mécanique des Chocs (LBMC UMR T9406), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), Department of Clinical Sciences and Orthopedics, Skåne University Hospital, Private praxis, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Movement Analysis Lab, Institute for Experimental Musculoskeletal Medicine University Hospital Muenster, School of Health and Life Sciences, Glasgow Caledonian University, Orthopaedic Surgery Department, Sant Rafael Hospital, Department of Traumatology and Orthopaedics, Centre of Postgraduate Medical Education, Foot and Ankle Surgery Unit, Orthopaedic Department ZNA Middelheim, Orthopaedic Department, Montallegro Clinic, Department of Orthopaedics and Rehabilitation, University Hospital in Krakow, Foot and Ankle Reconstruction Unit, Sint Maartenskliniek, Department of Orthopedics and Traumatology, Central Finland Health Care District, and Mater Private Hospital

Subjects
Male, Prom, [SPI]Engineering Sciences [physics], 0302 clinical medicine, lcsh:Orthopedic surgery, Surveys and Questionnaires, Item response theory, Orthopedics and Sports Medicine, Orthopedic Procedures, Societies, Medical, Language, Foot (prosody), 030222 orthopedics, food and beverages, [SPI.MECA.BIOM]Engineering Sciences [physics]/Mechanics [physics.med-ph]/Biomechanics [physics.med-ph], Middle Aged, Europe, medicine.anatomical_structure, Patient-reported outcome, Female, Adult, medicine.medical_specialty, FOOT, Article, VALIDATION, Likert scale, Classical test theory, Foot Diseases, 03 medical and health sciences, BIOMECANIQUE, Cronbach's alpha, Foot Joints, Medical, SCORE, medicine, Humans, Patient Reported Outcome Measures, PROM, business.industry, Reproducibility of Results, ANKLE, 030229 sport sciences, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], lcsh:RD701-811, Orthopedics, Physical therapy, Ankle, business, Societies, Foot, Score, Validation
Abstract

Category: Basic Sciences/Biologics Introduction/Purpose: A scientifically sound validated foot and ankle specific outcome measure for different European languages is still missing. Indeed, language-specific cross cultural validation in other languages than English is largely absent. Some outcome measures were validated for specific pathologies such as hallux valgus, ankle arthritis or flatfoot. The European Foot and Ankle Society (EFAS) established in 2013 a Score Committee to develop, validate, and publish a new score, the “EFAS Score”, which is not specific for single pathologies for different European languages. The principal aim of this project was to develop and validate the EFAS Score simultaneously for different European languages. Methods: The EFAS Score was developed and validated in three stages: 1) item (question) identification, 2) item reduction and scale exploration, 3) confirmatory analyses and responsiveness. The following score specifications were chosen: scale/subscale (Likert 0-4), questionnaire based, outcome measure, patient related outcome measurement. For stage 3, data were collected pre- operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using analyses from classical test theory and item response theory. Results: Stage 1 resulted in 31 general and 7 sports related questions. In Stage 2, a 6-item general EFAS Score was constructed using English, German, French and Swedish language data. In Stage 3, internal consistency of the scale was confirmed in seven languages: the original four languages, plus Dutch, Italian and Polish (Cronbach’s Alpha >0.86 in all language versions). Responsiveness was good, with moderate to large effect sizes in all languages, and significant positive association between the EFAS Score and patient-reported improvement. No sound EFAS Sports Score could be constructed. Conclusion: The multi-language EFAS Score has been successfully validated for orthopaedic foot and ankle surgery populations incorporating a wide variety of foot and ankle pathologies, including language-specific validation in seven languages so far (English, German, French, Swedish, Dutch, Italian, Polish). Validation for other languages (Danish, Finnish, Norwegian, Portuguese, Spanish, Turkish) is in progress. All validated score versions are freely available at www.efas.co .

Published
2018

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